January 12, 2016

Why a national pharmacare program is important

We asked two Saskatchewan experts to say why they believe Canada needs a national pharmacare program.

Dr. Ryan Meili, a Saskatoon family doctor

I watched a woman break into tears of joy in my office. She had just moved to Saskatchewan and is struggling financially. She needs medication for a chronic illness, but was suffering without it because she couldn’t afford the prescription. When I managed to find a way to get her a month’s worth for free, she was overjoyed. Being able to access necessary medications shouldn’t be a surprise and a huge relief; it should be the norm. But for the one in five Canadians who can’t afford to take their medications as prescribed, that’s not the case.

Canada is the only country with a universal health-care system that doesn’t include prescription drug coverage. The resulting inability to access medications worsens people’s health, either because they aren’t receiving proper treatment, or because they have to give up other necessities, such as food, to pay for drugs.

Failing to manage chronic illnesses like diabetes or hypertension can lead to further complications and hospitalizations. This means worse health outcomes for individuals, and higher costs to the health-care system.

Along with those added costs, we also pay higher prices for drugs, as individuals and as a country. A 2015 study in the Canadian Medical Journal estimated a savings between $4 billion and $6 billion per year if a universal pharmacare program was introduced. Ninety per cent of
Canadians surveyed want to see that changed. Doctors agreed, with over 90 per cent of delegates to this year’s Canadian Medical Association General Council voting in favour of pharmacare, which makes sense. We want to ask our patients what they need to be healthy, not how much they can pay. We’ve that right on access to doctors and hospitals. It’s time Canada got it right on medication coverage as well.

Tom McIntosh, associate director with the Saskatchewan Population Health and Evaluation Research Unit at the University of Regina

For decades now we have recognized that the patchwork of insurance coverage and non-coverage that exists for prescription drugs was one of the biggest failings of our much beloved, but also very stressed, health-care system in Canada.

A large minority of Canadians have employer-provided coverage, but that coverage is of varying quality in terms of what drugs are covered and how well they are covered.

The very poor, the unemployed, the unemployable, the elderly and sometimes children are picked up by a mix of provincial programs also with varying degrees of quality. And gaps between public and private coverage can mean those with chronic drug-dependent conditions or those faced with catastrophic illness are often saddled with huge out-of-pocket expenses. All the while, the proportion of our health-care budgets — both public and private — going to cover drug costs continues to rise. This leaves insurers, both public and private, little alternative but to reduce coverage to save money. We are paying ever more and getting ever less.

Collaboration between the provinces and the federal government on a pharmacare program that included a shared formulary, a single bulk purchaser of drugs and clear guidelines around both cost and medical effectiveness could save Canadians billions of dollars best spent elsewhere in the system.

The disconnected and unco-ordinated nature of prescription drug insurance is a key barrier to our ability to both ensure appropriate coverage for everyone and to contain what has become a major cost-driver within the health-care system.